So far we have a women who is 11 weeks pregnant and feeling tired and out of sorts. She has a microcytic anaemia and a borderline platelet count. Firstly let’s think about the anaemia. The two most common causes of anaemia in pregnancy are:

Iron deficiency

Haemoglobinopathy

Anaemia is exacerbated in pregnancy due to:

Increase in red cell mass

Blood loss

Increased maternal iron requirements

Iron needed by foetus and placenta

Dilution – increase in plasma volume

The MCV increases in pregnancy usully by 6Fl by about 26 weeks, so to have a microcytic picture would be unusual during pregnancy unless the patient has significant iron deficiency or a pre-existing haemoglobinopathy.

Questions:

What would you want to know before starting iron supplementation?

Are there any risks to iron supplementation?

When would you consider intravenous iron?

Which women are at risk of iron deficiency during pregnancy?

Why should iron be replaced? What are the risks of not replacing?

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